Knowledge, Attitudes, and Practices Regarding Prenatal Pilates Among Pregnant Women in Kuwait

Introduction: Regular physical activity during pregnancy supports maternal health.Prenatal Pilates (PP) is a low-impact exercise modality that may improve strength, postural control, core stability, and overall pregnancy well-being.However, evidence regarding pregnant women's knowledge, attitudes, and practices (KAP) toward PP in Kuwait remains limited.This study aimed to assess KAP regarding PP among pregnant women in Kuwait and identify factors associated with PP participation.Methods: A cross-sectional online survey was conducted between February and July 2026 among pregnant women aged ≥18 years residing in Kuwait.Participants were recruited through convenience sampling using social media, antenatal and gynecology clinics, and Pilates-related community settings.Data were collected using a study-specific Arabic questionnaire that underwent face and content validation (S-CVI/Ave = 0.80), pilot testing among 30 pregnant women, and reliability assessment (KR-20 = 0.88 for knowledge; Cronbach's α = 0.70 for attitudes).The questionnaire assessed sociodemographic and obstetric characteristics, knowledge, attitudes, exercise practices, barriers to PP participation, and self-reported lumbopelvic pain (LPP).Data were analyzed using IBM SPSS Statistics version 29.0.Although the target sample size was 385 participants, 186 eligible women were included in the final analysis.Results: A total of 186 pregnant women participated, of whom 155 (83.3%) had previously heard of Pilates.Among those aware of Pilates, 42.6% demonstrated good knowledge and 79.4% had positive attitudes, whereas only 29 participants (15.6%) were currently practicing PP.Knowledge scores were positively correlated with attitude scores (ρ = 0.492, p < 0.001), weakly positively correlated with educational level (ρ = 0.168, p = 0.037), and weakly negatively correlated with pregnancy order (ρ = -0.165,p = 0.040).Current PP practitioners had significantly higher knowledge (U = 588.0,p < 0.001, r = 0.46) and attitude scores (U = 1109.5,p = 0.001, r = 0.26) than non-practitioners.Educational level, monthly income, and medical educational background showed significant associations with current PP practice.Low energy and fatigue were the most commonly reported barriers.LPP was reported by 161 participants (86.6%), and 27 of 29 current PP practitioners (93.1%) reported at least some perceived improvement.Conclusion: Despite high awareness of Pilates and generally favorable attitudes toward PP, knowledge and participation remained limited among pregnant women in Kuwait.Higher knowledge was associated with more favorable attitudes, and current PP practitioners demonstrated higher knowledge and attitude scores than non-practitioners.Several sociodemographic characteristics showed exploratory associations with PP participation; however, these findings should be interpreted cautiously.The findings support the need for accessible, evidence-based educational initiatives to promote informed participation in prenatal exercise.Perceived improvement in LPP among current PP practitioners reflects self-reported experience and should not be interpreted as evidence of effectiveness.